C058 Adjustment Reason

To provide a reason and related explanation for a Health Care Claim or Service change in payment versus the original submitted charges

Position
Element
Name
Type
Requirement
Min
Max
Repeat
C058-01
Claim Adjustment Reason Code
Identifier (ID)
Mandatory
1
5
-
Code identifying the detailed reason the adjustment was made
C058-02
Code List Qualifier Code
Identifier (ID)
Conditional
1
3
-
Code identifying a specific industry code list
P0203: If either C058-02 or C058-03 is present, then the other is required
C05802 qualifies C05803, C05804, C05805, C05806 and C05807.
C058-03
Industry Code
String (AN)
Conditional
1
30
-
Code indicating a code from a specific industry code list
C058-04
Industry Code
String (AN)
Conditional
1
30
-
Code indicating a code from a specific industry code list
C0403: If C058-04 is present, then C058-03 is required
C058-05
Industry Code
String (AN)
Conditional
1
30
-
Code indicating a code from a specific industry code list
C0504: If C058-05 is present, then C058-04 is required
C058-06
Industry Code
String (AN)
Conditional
1
30
-
Code indicating a code from a specific industry code list
C0605: If C058-06 is present, then C058-05 is required
C058-07
Industry Code
String (AN)
Optional
1
30
-
Code indicating a code from a specific industry code list
C0706: If C058-07 is present, then C058-06 is required

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